A True Referendum on Health Reform?

Since even before President Obama signed the Democratic health care reform bill into law, federal elections have been examined as potential referendums on that bill. Most notably, the dramatic turn in Massachusetts, when Scott Brown defeated Martha Coakley to steal Democrats' 60-seat supermajority, was pushed as a rejection of health reform by voters.

But now voters in a true bellwether state--Missouri, which votes for the next president more often than any other state (except in 2008)--have gone to the polls and registered their opinions directly on the new law. Last night, Missourians passed Proposition C, a measure to ban the federal mandate that individuals must purchase health insurance.

The margin was overwhelming: Missourians voted 71% to 29% in favor of the measure, and against the individual mandate.

On its face, this looks like a clear victory for those who oppose health reform--proof, once and for all, that voters really don't like the new bill.

But before we get too excited, here are a few things to keep in mind:

  • First, Proposition C is on shaky legal ground. The Constitution's supremacy clause clearly states that federal law supersedes state law, so even if Missouri voters don't think they should have to abide by the new law, they likely will.

  • This wasn't necessarily a great sample of Missouri voters. Also on the ballot was a contested Republican Senate primary, which drew more than twice the votes as the uncontested Democratic Senate primary. By that indication, many more Republicans than Democrats turned out for this vote.

  • This was only a vote on the individual mandate, not the new law as a whole. Coincidentally, the individual mandate polled worse than health care's other provisions when broken down by pollsters. If a vote were held on whether people wanted insurance subsidies, or even regional health exchanges, the outcome may have been different.

  • On the other hand, a handful of states are pressing ahead with legal challenges to the federal law. A case brought by Virginia AG Ken Cuccinelli will be heard in October, and this vote may add some momentum to that push by encouraging its supporters.